Constipation

Constipation

Toilet Training for Adults

These days, there are no hard-and-fast rules on how often you need to move your bowels to be considered "regular."

Though most people average a bowel movement somewhere between once a day and three times a week, doctors say that you are not necessarily constipated if you move your stools less frequently. Constipation is defined as a decrease in your usual number of bowel movements.

So, let's say that you normally go once a day, and you suddenly only need to defecate once a week. That's constipation.

Doctors blame diets high in processed foods and low in fruits, vegetables, beans, grains and other sources of fiber. Fiber moves the bowels. Yet most Americans eat considerably less than the amount needed for a healthy colon. We should get 20 to 35 grams of fiber a day. Instead, we get as little as 5 grams a day.

Though opinions differ on whether women get more constipated than men, they definitely make more doctor visits. It is also known that hormonal changes during pregnancy and the pressure on the abdomen caused by childbirth often lead to constipation.

Women also often get constipated in the week or so before menstruation. This is because fluids that normally flow to the colon, softening and moving stools, are retained in other parts of the body, says Nicolette Francey, M.D., professor of medicine at New York Medical College in Valhalla and a medical consultant for primary care at the Doctor's Consultants, a physicians' organization in New York City.

If you experience constipation, take heart. Women doctors say that retraining toilet habits, adding fiber to your diet and exercising regularly can get those sluggish stools on the go again.

GET MOVING NOW

"Except in rare cases, the last thing that you should take is a chemically based laxative like Ex-lax or Correctol," says Dr. Francey. That's because excessive laxative use is likely to make your bowel lazy, which means that you won't be able to go without help. Worse, laxatives often set up a vicious cycle, in which you are constantly alternating between constipation and diarrhea, and never have regular bowel movements.

But sometimes you just need something. Now.

Try hot broth (or other natural laxatives). "If you have mild discomfort from constipation because you're traveling and can't get to the gym or eat your fruits and vegetables, try a glycerine suppository, milk of magnesia or prune juice," says Joanne A. P. Wilson, M.D., a gastroenterologist and professor of medicine at Duke University Medical Center in Durham, North Carolina. "Sometimes even a warm cup of broth will help your bowels move more quickly."

Use a footstool. "If you're constipated, propping your feet up on a stool with your knees bent while you sit on the toilet will straighten the angle of your bowel and help you pass stool more quickly," says Jacqueline Wolf, M.D., a gastroenterologist, assistant professor of medicine at Harvard Medical School and co-director of the Inflammatory Bowel Disease Center at Brigham and Women's Hospital in Boston.

THE DIETARY FACTOR

What you eat and when has a significant bearing on regularity. Here's what women doctors advise.

Don't skip meals. Often women--especially dieting women--get constipated because they eat only one large meal a day, says Dr. Wilson. "Eating stimulates the reflex that causes stuff to move forward in the gut. Women who diet often eat fewer meals to cut calories. That decreases movement through the gut."

When nothing moves, you can't pass stool. Breakfast is particularly important, because that's what starts your digestive juices flowing every day.

Fill your meals with fruit. Fiber creates soft, mobile stools, says Elaine Feldman, M.D., professor emeritus of medicine at the Medical College of Georgia School of Medicine in Augusta. "You don't have to eat a pound of bran a day; just treat yourself to three servings of vegetables and two fruits a day and some whole-wheat bread."

Introduce fiber slowly. "Too much fiber too fast may solve your constipation, but replace it with gassiness, bloating and diarrhea," Dr. Feldman says.

Meanwhile, try a supplement. Some women complain that they can't digest that much fiber. If that describes you--or if you're working fiber into your diet--try a fiber supplement such as Metamucil, Citrucel or Fibercon, says Linda Lee, M.D., assistant professor of medicine in the Division of Gastroenterology at Johns Hopkins University School of Medicine in Baltimore.

Available in supermarkets and drugstores, supplements can be taken in granular form (mixed in water or juice) or wafer form, washed down with at least eight ounces of fluid. Fiber supplements soften and bulk up stool and nix constipation.

Drink a lot. Drink six to eight 8-ounce glasses of water daily to soften the stool, says Robyn Karlstadt, M.D., a gastroenterologist at Graduate Hospital in Philadelphia. Fill an empty 64-ounce soda bottle with water and keep it at your desk, then help yourself until it's gone.

To end constipation permanently, you'll also need to change some lifestyle habits, including the way you sit on the pot, says Dr. Wilson.

If you have chronic constipation, your bowel may have forgotten its job, because you've been ignoring its needs. You may need to relearn some good potty habits to refresh its memory.

Make a toilet date--and keep it. You wouldn't dream of leaving the house without doing your hair. So why not take the same care with your colon?

Eating, especially in the morning, is a wake-up call to the bowel, says Dr. Wilson. Yet what people do is get up, race out of the house, stop on the way for breakfast and head to the office. That doesn't give your bowel a chance to respond. And public bathrooms are not usually conducive to quiet time, and this causes further and further delays, says Dr. Francey.

The answer?

"Schedule time at home in the morning," says Dr. Francey. "Usually, the bowel is ready to expel its contents about half an hour after the first meal."

Sit rather than strain. Trying to force out hard, dry, recalcitrant stool won't relieve your constipation; it may lead to hemorrhoids and a protrusion of rectal tissue through your anus, also known as prolapse of the rectum, says Dr. Wilson.

If you really can't go after 15 minutes, get off the pot and try again later.

Make a commitment to exercise. If nothing else, "just move around," Dr. Francey says. No one is sure why, but exercise stimulates bowel function. However, heavy exercise may cause dehydration, so remember to replenish water loss by drinking plenty of water, says Dr. Francey.

It doesn't take much. Walking, swimming or performing any other aerobic exercise for half an hour three times a week may be enough to cancel your constipation, says Dr. Francey.